Australian women turning to cannabis to treat endometriosis symptoms

Australian women turning to cannabis to treat endometriosis symptoms

How serious is endometriosis? Common symptoms include pelvic pain and fatigue, with many women reporting significant negative impact on their life including on education, work, friendships, and sexual relationships. Learn how cannabis is helping manage symptoms of this often undiagnosed condition that affects millions worldwide.   A new study published in Journal of Obstetrics Gynaecology Canada has found one in eight Australian women with endometriosis use cannabis to alleviate pain and other symptoms, rating the plant based medicine as the most effective way to self-manage the disorder. Researchers from NICM Health Research Institute, Western Sydney University and UNSW Sydney surveyed 484 Australian women with endometriosis between the ages of 18 and 45 to determine the types of strategies they used to self-manage symptoms. They found more than three quarters of Australian women with endometriosis are turning to self-management strategies including breathing techniques, yoga, dietary changes, heat and cannabis. Cannabis was ranked as the most effective treatment by women. The women said that along with reducing pain, they felt that cannabis significantly reduced symptoms of nausea and vomiting, gastrointestinal symptoms, problems with their sleep, feelings of depression and anxiety. Women using cannabis also reported a decrease in the medication that they normally took for their endometriosis symptoms, with just over half saying they decreased their medication by 50 per cent or more. Reported side effects were mild and relatively rare. Endometriosis is a chronic condition where tissue similar to the lining of the uterus is found outside the uterus, and commonly causes pelvic pain and fatigue, with many women reporting significant negative impact on many aspects of their life including education and work, friendships, and sexual relationships. In Australia, around one in nine women born between 1973-78 were diagnosed with endometriosis by age 40-44. The condition may cost up to $9.7 billion in Australia per year, mostly through productivity losses. Aside from surgery, current treatments for endometriosis include use of oral contraceptive or progestogens, and non-steroidal anti-inflammatory drugs, which do not always provide adequate pain control, or have side effects that are hard to tolerate for some women. Opioid analgesics are often prescribed for pain, however there is a risk of dependency and overdose. Lead author on the study, NICM Health Research Institute Research Fellow and Coordinator of the Australian Medicinal Cannabis Research and Education Collaboration, Justin Sinclair said that due to the limitations of existing medical treatments for endometriosis, women are turning to self-care or lifestyle interventions for symptom relief and research is needed into the effectiveness of these self-management strategies. “Cannabis has a long history of use in the ancient and scientific literature for various conditions such as period pain, however until now nothing has been investigated for cannabis being used for endometriosis,” Mr Sinclair said. “Past research has demonstrated that certain compounds within cannabis known as cannabinoids exert analgesic and anti-inflammatory activity. Our research sought to determine the prevalence, tolerability, and self-reported effectiveness of cannabis in women with endometriosis.” Although the study showed promising results for the use of cannabis for endometriosis symptoms, Mr Sinclair cautioned that cannabis use was not without risk, however the reported rates of adverse effects were low in their study. “One in ten women in the study who used cannabis reported an undesirable effect such as drowsiness, rapid heartbeat, or increased anxiety,” he said. According to Chief Investigator on the study NICM Health Research Institute’s Dr Mike Amour, Australian law currently requires legal medicinal cannabis use to follow specific, regulated pathways that limit prescription by this method; however, self-reported illicit use of cannabis remains relatively common in Australian women with endometriosis. “Due to the timing of when the survey was administered, most if not all of the women in the survey would have been using illicit cannabis as access to medicinal cannabis was still in its infancy,” Dr Armour said. “This means we don’t have any information about the different varieties of cannabis that women were using, or what might have been in the cannabis that was being used as it was derived from illicit sources which are not quality assured. Also, this was a self-reported survey, which can lead to over or under estimation of the positive or the negative effects. “Further research is needed to assess the effectiveness of quality controlled medicinal cannabis and women with endometriosis.” Copyright © 2019 NewsRx LLC, Education Daily Report   This article was originally published on The Cannigma, and shared here with permission.

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Ancient Egypt’s rich history of medical cannabis

Ancient Egypt’s rich history of medical cannabis

Cannabis, in all its forms, has played an important role in many societies across all corners of the globe for millennia. Let’s take a trip through Egyptian history.   In Egypt, medical cannabis use goes back for millennia.  And while many different early cultures cultivated cannabis, the ancient Egyptians exemplified a truly holistic use of the plant. It’s even possible that cannabis — Egyptian hieroglyphs called it shemshemet — became popular before the great pyramids were built.  Egypt’s historical use of shemshemet appears twofold. On one hand hemp may have been used for fiber and textile; on the other hand, the more psychoactive components of cannabis may have been used medicinally. Though many sources today appear authoritative in their claims that the ancient Egyptians used hemp for this and cannabis for that, a closer inspection of the evidence is needed.  Let’s take a trip back through Egyptian history, beginning around the year 3,000 BC. Marijuana Hints in Historical Egyptian Records Luxor, Egypt: KV9, Kings’ Valley No. 9, Tomb of Memnon, tomb of the pharaohs from the 20th dynasty: Ramses V and Ramses VI (Shutterstock) While the exact timeline is less than crystal clear, cannabis was likely used in ancient Egypt as many as 5,000 years ago. Some speculate that depictions of the Egyptian Goddess of writing, Sheshat, are brimming with cannabis-inspired themes. In many paintings, she’s shown with a star-shaped leaf atop her head and a fibrous rope in her hand. Was Sheshat’s creative ability courtesy of some help from hemp? It’s a fun theory, but let’s move on to more evidence-based examples.  First, it’s important to understand the context in which Egyptian medicine found itself. The culture’s understanding of the human body was far ahead of its time, and, relatively speaking, extraordinarily advanced. Although the ancient Egyptians preceded Pasteur’s germ theory by thousands of years, they nonetheless placed a great value on cleanliness and sanitation. And customs like embalming added to the Egyptian’s understanding of how the human body worked. This same medical knowledge lent itself to the extensive use of medicinal plants. At first, this usage blurred the lines — merged them, even — between science and religion. As Egyptologist Barbara Watterson notes, “the earliest ‘doctor’ was a magician, for the Egyptians believed that disease and sickness were caused by an evil force entering the body.” Thankfully, plant-based incantations seemed to be a perfect cure.  Soon enough, cannabis was discovered as among the best and most powerful of these plant-based preparations. Its dual psychotropic and healing properties likely made cannabis popular among the dual doctor-magicians of ancient times. And while it’s unclear exactly when cannabis use became mainstream, the plant’s residue has been found in Egyptian artifacts dating back to more than 4,000 years ago. Around 2,000 BCE, cannabis salves were used to treat eye sores and glaucoma. Today science has proven what the ancient Egyptians learned through centuries of experience: that cannabis is a potent anti-inflammatory which reduces intraocular pressure. Another Egyptologist, Lise Manniche, notes in her book An Ancient Egyptian Herbal that several texts dating back to the 18th century BCE encouraged readers to “plant medicinal cannabis.” Cannabis Referenced In Ancient Scrolls Egyptian papyrus (shutterstock) It’s now fairly common knowledge that Egypt was a pioneer in the development of papyrus and parchment papers. With these scrolls came the culture’s ability to write and document — and our ability to take a glimpse into their world. Papyri covering everything from legal topics to mythological tales to medical records have been found, and naturally, the medical papyri sometimes mention cannabis. The Ramesseum Papyri | According to The British Museum, the Ramesseum Papyri “have been described as the ‘most precious single find of papyri’ from pharaonic Egypt.” As one of the oldest medical records ever discovered (circa ~ 1750 BCE), it’s likely these tales reflect a cumulative buildup of the healing techniques of even earlier generations. The Ramesseum Papyri get their name from their origin: the ancient city of Ramesseum. Researchers have uncovered countless other gems from this Ramesses II-built city, nearly all of which points to the era’s educational prowess.  The Papyri themselves point to this, too. They include information about childhood illness, anatomy, recovery from volcano-induced injuries, and the birthing process. Plate A26 of the Ramesseum III Papyrus describes this treatment for the eyes: “celery, cannabis is ground and left in the dew overnight. Both eyes of the  patient are to be washed with it in the morning.” Could this have been an effective early THCA therapy?  The Ebers Papyri | This remarkable collection of papyrus scrolls is the world’s oldest complete medical book. Written around 1500 BC, it describes its era’s most popular medicinal remedies. The Ebers Papyri gets its name from botanist George Ebers, who obtained it in the late 1800s. Like many others in his field, Ebers was understandably interested in gleaning whatever he could from the ancients. And with 700 medical and magical formulas spanning 110 pages, it seems there’s a lot to glean.  A formula for feminine health is as follows:  Formula No. 821: Shemshemet (i.e., cannabis) was to be “ground in honey; introduced into her vagina to cool the uterus and eliminate its heat.” Another cannabis-based formula for “a painful finger or toe” is effective enough that physicians are instructed to encourage their patients — “you must say to this patient: ‘A problem that I can treat’.” Formula No. 821: “honey: 1/4; ochre 1/64; cannabis: 1/32; hedjou resin: 1/32, ibou plant: 1/32. Prepare as for the preceding, and dress [the affected area] with it.” The Berlin Papyri | This slightly newer scroll (circa ~1,300 BCE) points towards the evolution of cannabis as medicine. It wasn’t just good for eye problems, feminine issues, or inflamed extremities — cannabis could be used to treat fever and inflammation too.  The papyri’s 81st formula shows that cannabis was prescribed as an “ointment to prepare for driving away the fever.” Today, modern medicine has made these same anti-fever, anti-inflammatory qualities abundantly clear.  The Chester Beatty Papyri | Also written around 1,300 BC is the Chester Beatty papyri. This artifact is geared mostly towards treating colorectal diseases. It likely mentions shemshemet at least twice and prescribes the plant’s crushed seeds as a valuable cure. There are even instructions on the use of cannabis suppositories for digestive purposes.   Overall, examples of cannabis use within the papyri records are somewhat sparse. But the ones that are present are also very telling. As Dr. Ethan Russo quotes in a 2007 publication in the Journal of Chemistry and Biodiversity, “as a drug, it [cannabis] has remained in active use ever since pharaonic times. It does not appear very often in the medical papyri, but it was administered by mouth, rectum, vagina, bandaged to the skin, applied to the eyes and by fumigation.” Cannabis for the Pharaohs, Cannabis for All The Front of the Abu Simbel Temple, Aswan, Egypt (Shutterstock) Egyptian pharaohs may have used cannabis for more ceremonial purposes, too. The remains of Ramses the Great (Pharao in 1213 BCE) contain traces of cannabis, as do the remains of other mummified Egyptians. In the 1990s a series of studies from Nerliche, Parsche, and Balabanova reported this surprising find. Nerliche’s study noted that mummies had a significant deposition of tetrahydrocannabinol (THC) and concluded that this was likely obtained through cannabis smoke. As you might imagine, these studies were very controversial when they first came out.  As time went on Egyptian use of medical cannabis continued to develop. By around 1,000 BC, it seems as though even Egypt’s common people had caught on to the plant’s potential benefits. Unfortunately, though, there is relatively less historical data on cannabis use during this time period.  Cannabis as a medical remedy? Could the ancient Egyptian’s understanding of cannabis have trickled down to adeptness in other areas related to health and the body? Perhaps. In his epic work The Odyssey, Homer notes that “everyone in Egypt is a skilled Physician”. Everyone, in this case, even included women — which was a very rare allowance in those times. Indeed, some of Egypt’s first doctors were women prized for their caregiving; other women were skilled as midwives.  A final papyrus-written record surfaced around 200 AD: the Vienna Papyri. This one appears to mention cannabis as a treatment for tumors, ear pain, and fevers. In some instances, the Vienna papyri recommend using acacia and cannabis in conjunction. Though not truly ancient, this one distills down information gathered from prior time periods.  Translation difficulties make coming to a full knowledge of the Egyptian’s medical cannabis use challenging, though researchers like Dr. Greg Gerdeman agree that ancient mentions of shemshemet most definitely refer to cannabis. What can be said with full confidence is that the ancient Egyptians were leaders in the medical world of their era — and they attained this leadership through devotion to medicinal plants like cannabis.  It’s likely that practical lessons can be learned from their devotion, too.  Perhaps Dr. Russo’s review said it best: “information gleaned from the history of cannabis administration in its various forms may provide useful points of departure for research.” In the future, the wisdom of the ancient Egyptians may truly come full circle.    This article was originally published on The Cannigma, and shared here with permission.

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Effects of cannabis on your body

Effects of cannabis on your body

With hundreds of active compounds in cannabis, cannabis has a multiplicity of effects on the human body, including some that are less known and fascinating. Read on...   If you ever stop and think about it, the human body is a marvel of nature and evolution that defies all superlatives. Now imagine there was a system that ran through the microscopic constellation that makes up our physical form — and you could modulate it using cannabis. If that strikes you as strange, then take a minute to get acquainted with your body’s endocannabinoid system.  What is the endocannabinoid system? First discovered by scientists in the 1990s, the endocannabinoid system is responsible for regulating all types of functions of the human body. There are two main receptors of the ECS, known as CB1 and CB2. These can modulate all types of systems in the body, and one of the ways they can be affected is through the use of cannabis-based compounds called cannabinoids (“phytocannabinoids”).   Let’s take a look at seven of the main body functions and systems that the ECS plays a key role in. 1. Memory and learning Cannabis is well-known for the effect it can have on short-term memory, but it’s more complicated than that. The cannabinoid tetrahydrocannabinol (THC) activates CB1, which is found throughout the brain, including in the hippocampus, which is responsible for memory. In addition, the CB1 receptor is responsible for what’s known as extinction learning, the process which allows new information to overwrite old memories — including traumatic ones. This is one of the reasons that cannabis can be an effective treatment for PTSD.  2. Appetite regulation (Marina Boyarkina/123rf) Studies have shown that cannabinoid receptors play an essential role in regulating food intake and metabolization. And while everyone knows the stereotype of the pot smoker feasting on snack foods during a serious case of the munchies, there’s also strong evidence that the ECS could help manage obesity and eating disorders. In addition, research has found that cannabis users had significantly lower BMIs and obesity rates compared to non-cannabis users.  3. Thermoregulation Behind the scenes, without us ever knowing, our bodies maintain a core temperature despite different external environmental temperatures and factors. The ECS plays a role in thermoregulation as well, and can raise the core temperature of the human body in order to fight off infection. Thermoregulation can also protect against strokes, in addition to viral and bacterial infection.  4. Female reproductive processes (Dmytro/123rf) The ECS plays an important and complex role in the secretion of hormones related to reproductive functions. Some scientific evidence has shown that cannabis has the potential to reduce female fertility by disrupting the production of estrogen and progesterone hormones, potentially delay the ovulation cycle or prevent it altogether.  At the same time, ECS involvement in female reproduction suggests modulation of the endocannabinoid system is essential for reproductive success. 5. Immune system function (nuclearlily/123rf) The ECS is generally considered a “gatekeeper” for the immune system, largely through its ability to suppress the immune system. This is one reason that cannabis can be effective in treating auto-immune conditions like irritable bowel syndrome or rheumatoid arthritis. This effect is also a reason that some cannabis products are being studied as potential treatments to stave off the “cytokine storm” over-reaction of the immune system, including in patients with COVID-19.  6. Sleep and sleep cycles (stockme/123rf) Cannabis is a popular treatment for insomnia, and research has shown that the activation of CB1 receptors can induce sleep in laboratory settings. At the same time, cannabis use can actually reduce REM sleep — the phase of sleep during which dreams happen.  7. Pain perception (serezniy/123rf) Chronic pain is the most common reason patients are prescribed medical marijuana. This is because the ECS is one of the main systems responsible for the regulation of pain. ECS receptors are found in various parts of the peripheral and central nervous system, and nearly every part of the body’s pain pathway. Read more about the endocannabinoid system and how cannabis affects it.   This article was originally published on The Cannigma, and shared here with permission.

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Lesser known effects of cannabis on your body

Lesser known effects of cannabis on your body

Countless people turn to cannabis medicine to help manage pain, relieve stress, ease anxiety, or to simply improve mood. There is no shortage of effects that cannabis has on the human body, including some that aren’t obvious.   Cannabis can be a relaxing break at the end of the day, a hobby to share with friends, and a fun and hilarious way to make movies, music, and TV shows a lot more enjoyable. But with hundreds of active compounds in marijuana, there is no shortage of effects it can have on the human body, including some that aren’t obvious.  The effects of cannabis have a lot to do with the endocannabinoid system (ECS), which exists in all vertebrates and which plays a key role in regulating all types of crucial functions such as sleep, pain, and appetite.  Our bodies produce their own cannabinoids, but the ECS can be stimulated by at least some of the more than 140 cannabinoids found in cannabis (“phytocannabinoids”) — like THC — producing the plant’s effects on the human body.  Let’s take a look at some of these lesser known effects.  Cannabis users had significantly lower BMIs and obesity rates compared to non-cannabis users. (Joshua Resnick/123rf) 1. There’s a correlation between cannabis and lower weight  The stereotype of the stoner anchored to the couch, feeling the “munchies” and devouring bags of chips is for many people the image of cannabis. Research has shown however, that while cannabis does boost your appetite, it may actually have a correlation to lower body weight.  A 2018 meta-analysis of existing research found that cannabis users had significantly lower BMIs and obesity rates compared to non-cannabis users. The researchers suggested that acute cannabis consumption “reduces energy storage and increases metabolic rates.” Some animal based studies suggest that THCV, a minor cannabinoid that can be found in varying concentrations in different cannabis cultivars, “can suppress food consumption and body weight”.   And while further research has confirmed that obesity rates are higher in people who don’t use cannabis, there may also be a simpler, anecdotal explanations to bolster these assertions about cannabis and weight loss: Cannabis can be relaxing and therapeutic, and stress can be a strong cause of over-eating (as anyone who has put on weight recently during the lockdowns can tell you).  2. It can help PTSD — by overwriting traumatic memories? Post-Traumatic Stress Disorder is a qualifying condition for medical marijuana in many states and research has shown cannabis has the ability to reduce PTSD symptoms and improve sleep quality in patients.  But what may be more interesting is one of the reasons for why cannabis can be effective against PTSD. Scientists found that one of the main receptors that cannabis interacts with, the CB1 receptor, is responsible for extinction learning. This process allows new information to overwrite old memories — including traumatic ones.  According to a theory by Yale Associate Professor of Psychiatry R. Andrew Sewell, stimulating CB1 receptors with cannabinoids could alleviate PTSD symptoms and possibly cure the condition by allowing extinction learning to take place — overwriting traumatic memories. Prior to his death in 2013, Sewell had launched a study to examine how the administration of cannabis can help veterans undergo “exposure therapy,” during which they revisit their trauma repeatedly until it is no longer debilitating.   A simpler explanation for how cannabis can help with PTSD is simply the fact that it can help improve sleep quality. 3. It can both lower and raise anxiety With its relaxing effects, cannabis is very frequently used to ease stress and anxiety. One study from 2015 found that the endocannabinoid system “seems to determine the value of fear-evoking stimuli and to tune appropriate behavioural responses.” A later study carried out in 2017 asserted that chronic cannabis use “is associated with blunted stress reactivity,” and can lessen how people react to stressful stimuli. Cannabis can have a different and even opposite effects with smaller or larger doses. (Maria Dubova/123rf) But you can’t talk about the effects of cannabis on stress and anxiety without discussing its “biphasic effect” — that is, cannabis can have a different and even opposite effects with smaller or larger doses. Cannabis, especially in larger or more potent doses, can spark anxiety, panic, and paranoia in users. People who are prone to anxiety may prefer to start off with a small dose, or to “microdose” cannabis until they see how their body responds.  Another factor that might influence the anxiety reducing effects of cannabis is terpenes. Cannabis is more than just THC and CBD — there are hundreds of other compounds with different effects. Some terpenes such as myrcene, alpha-pinene, limonene and linalool have shown anxiety reducing properties, which suggests that cannabis varieties with higher concentrations of these terpenes might be more effective for treating anxiety than others.  4. Rare but frightening: Uncontrollable nausea and vomiting  You likely have never heard of this condition, but cannabinoid hyperemesis syndrome (CHS) is a rare and serious side effect of chronic cannabis use that causes repeated, severe instances of vomiting, nausea, and abdominal pain that can last for days. Before being diagnosed, patients are typically able to temporarily relieve the symptoms by taking a hot shower — sometimes for hours on end. The only known way to treat CHS, however, is to stop using cannabis. The condition seemingly runs counter to the strong antiemetic (anti-nausea) properties of cannabis. In fact, many patients actually increase their cannabis use before they are diagnosed, because they believe it will help ease their nausea.  Although it is not known exactly what causes cannabinoid hyperemesis syndrome, one theory posits that stimulating the CB1 receptor can cause negative effects on the gut, such as delayed gastric emptying and altered intestinal motility, but that most of the time the antiemetic properties are more powerful.  5. Suppressing REM sleep — and dreams  Many people who have taken a break from cannabis notice very quickly that they suddenly start dreaming more, or at least they find they remember their dreams much more than before. The dream-suppressing effects of cannabis can mean bizarre, vivid or very lucid dreams — or even nightmares — if one stops using it suddenly.  This is also one reason that cannabis can help people suffering from PTSD — by suppressing the nightmares that keep them from getting a decent night sleep.  A 2008 study found that “smoked marijuana and oral Delta-9-tetrahydrocannabinol (THC) reduce REM sleep.” At the same time, that study stated that “difficulty sleeping and strange dreams” are among the most consistently reported symptoms of acute and subacute cannabis withdrawal.”  Ultimately, while the suppression of dreams can inhibit the brain’s ability to clean out “toxic byproducts,” cannabis is a highly-effective sleep aid and can help people suffering from insomnia and nightmares to get the rest they need.  From the munchies to red eyes, a dry mouth and a tendency to laugh at things that objectively perhaps aren’t that funny, cannabis has many effects that are common knowledge. But the plant actually has a far broader range of potential benefits — and side effects — and as research continues into what makes cannabis work, we’ll get an even richer concept of how and when to use it.   This article was originally published on The Cannigma, and shared here with permission.

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Cannabis for wellness

Cannabis for wellness

Chronic conditions needn't come in the way of happiness and well-being of a patient. A lesser known fact - wellness and disease can coexist! Read on...   Much can be said about the potential of cannabis to improve human health. Scientific studies are being published almost every day showing the potential benefits of cannabis for everything from epilepsy to chronic pain to psoriasis and brain trauma. However, cannabis’ potential does not end at treating life-altering diseases and conditions. Marijuana can also be used to improve and enrich life in many other dimensions. Wellness is a concept that arose in recent decades to describe a state of being that is far beyond health, and includes physical, mental, and social well-being. According to scholars from Stanford University and the London School of Economics, wellness refers to “choices and activities aimed at achieving physical vitality, mental alacrity, social satisfaction, a sense of accomplishment, and personal fulfilment.”1 Following this definition, wellness is not reserved for the healthy. While health and disease can be antonyms, wellness and disease can coexist, and patients with long-lasting conditions can enjoy elevated states of well-being. 1. Reducing daily stress One doesn’t have to be diagnosed with an anxiety disorder to experience anxiety. (Shutterstock) One of the most common reasons people consume cannabis is as a way to cope with the stress of daily life. According to the American Institute of Stress, stress is most commonly defined as “physical, mental, or emotional strain or tension.” While scientists agree that a certain amount of “good stress” or “eustress” is positive for tackling the daily challenges of life, too much of it can have serious consequences in health and well-being. According to a report by the American Psychological Association, 77% of Americans regularly experience physical symptoms caused by stress like fatigue, headaches, stomach ache, and muscle tension, and 73% regularly experience psychological symptoms due to stress like irritability and sadness. While stress is a response to an external factor, anxiety is considered the internal reaction to that response. In that way, one doesn’t have to be diagnosed with an anxiety disorder to experience anxiety due to money, work or relationship trouble. Cannabis, especially at lower doses, may be a positive tool in reducing stress and anxiety. One study of over 11,000 cannabis use sessions found that over 58% of participants had a reduction of these symptoms after consuming THC-rich cannabis at lower doses. CBD has been found to reduce stress-related anxiety regardless of the dose. 2. Improving focus Cannabis can help many people focus on one task. (Shutterstock) Many people who choose to consume cannabis for extra-medical reasons do it in their leisure time. Others use it to tackle everyday activities like work or study. Most scientific research relating cannabis to concentration has been done in regards to serious medical conditions like attention deficit hyperactivity disorder (ADHD). While this field of study is still being explored, there’s a strong link between ADHD and dysregulation of the endocannabinoid system, and  preliminary evidence suggests that cannabis may improve symptoms of ADHD. For those who don’t suffer from a diagnosed attention deficit disorder but still could use a hand getting things done, cannabis can be of help. In recent years, a large amount of anecdotal evidence has been accumulated by many users who report that specific cannabis chemovars help them “get in the zone” at work or other activities that require focusing2[/efn_note]. This may be a result of the plant’s potential to block out outside stimuli and place one’s full focus on the current task at hand. 3. Sparking creativity People have been using cannabis to spark creativity at least for decades, although probably for thousands of years. (Shutterstock) The use of cannabis among the artistic and creative communities throughout history is very well documented. However, one doesn’t have to be a famous musician from the 1960s to take advantage of cannabis’ potential for creativity. Creative problem solving is an ability that can be applied to any aspect of life, and is especially helpful in work environments.  THC, cannabis’ primary psychoactive compound, has been found to stimulate the release of dopamine in the brain3. Dopamine is a neurotransmitter that has been widely associated with “divergent thinking,” which is the ability to form loose associations in order to come up with new ideas4. Divergent thinking is described as one side of the creative process, while “convergent thinking” is the other. In order to generate novel ideas and solutions, the loose associations sparked by divergent thinking must be converged into a working solution to the problem at hand. However, another study found that too much THC can actually hinder divergent thinking5. In this research, lower doses of THC are found to produce better creativity.  While the scientific study of cannabis in relation to stress reduction, concentration and creativity is still at its first steps, a lot of anecdotal evidence shows that the use of the plant for this purpose has existed for many decades, even centuries.   Sources: Naci, H., & Ioannidis, J. P. (2015). Evaluation of Wellness Determinants and Interventions by Citizen Scientists. JAMA, 314(2), 121–122. https://doi.org/10.1001/jama.2015.6160 Mitchell, J. T., Sweitzer, M. M., Tunno, A. M., Kollins, S. H., & McClernon, F. J. (2016). “I Use Weed for My ADHD”: A Qualitative Analysis of Online Forum Discussions on Cannabis Use and ADHD. PloS one, 11(5), e0156614. https://doi.org/10.1371/journal.pone.0156614 Bossong, M. G., van Berckel, B. N., Boellaard, R., Zuurman, L., Schuit, R. C., Windhorst, A. D., van Gerven, J. M., Ramsey, N. F., Lammertsma, A. A., & Kahn, R. S. (2009). Delta 9-tetrahydrocannabinol induces dopamine release in the human striatum. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 34(3), 759–766. https://doi.org/10.1038/npp.2008.138 Käckenmester, W., Bott, A., & Wacker, J. (2019). Openness to experience predicts dopamine effects on divergent thinking. Personality neuroscience, 2, e3. https://doi.org/10.1017/pen.2019.3 Kowal, M. A., Hazekamp, A., Colzato, L. S., van Steenbergen, H., van der Wee, N. J., Durieux, J., Manai, M., & Hommel, B. (2015). Cannabis and creativity: highly potent cannabis impairs divergent thinking in regular cannabis users. Psychopharmacology, 232(6), 1123–1134. https://doi.org/10.1007/s00213-014-3749-1   This article was originally published on The Cannigma, and shared here with permission.

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Can you live a normal life with fibromyalgia?

Can you live a normal life with fibromyalgia?

There is increasing interest in cannabis medicine as treatment for fibromyalgia. This is not just due to its effects on nociplastic pain (analgesic properties) but also due to its potential to help with other associated symptoms such as insomnia, anxiety and depression.   ‘I feel almost the same as before I was diagnosed with fibromyalgia’ Sometimes, where you’re meant to be is 180 degrees from where you started out. That seems to be the case with cannabis for Dr. Michele Ross.  “I started off really against drugs,” Ross told The Cannigma, describing her childhood dream of becoming a doctor to help tackle societal problems of addiction. “I actually wanted to help people get off of drugs.”  Ross did become a doctor in the end, but a major part of her work as a neuroscientist involves helping patients find relief through the use of medicinal cannabis.  Like many cannabis skeptics before her, it was a personal diagnosis that changed her relationship with the plant.  While studying for her PhD at the University of Texas Southwestern in 2006, she was assigned a paper about how cannabinoids affect the brain. To her surprise, the work concluded that cannabis can be beneficial.  Dr. Michele Ross (Courtesy) A few years later, she woke up one morning and one of her hands simply stopped working. She initially thought she slept on it funny, but weeks later the hand was still asleep and she was still in pain. Ross was eventually diagnosed with fibromyalgia, which she blames in part on the chemicals she exposed herself to during her lab work.  “I probably Spidermanned myself but instead of superpowers I just got super chronic pain,” Dr. Ross said.  Her physicians put her on a regimen of painkillers and other prescription medications that she said left her edgy, irritable, miserable, and wanting to take her own life.  Eventually, she decided to try a homemade cannabis topical that she would massage on her skin, helping “the nerves wake up,” she said.  The topical is nothing fancy, Ross said, just a mix of high-THC cannabis, coconut oil, and peppermint oil. Ross said the THC is much more helpful than CBD creams, adding that “the menthol in the cream helps me more than the CBD.” Today she takes a 10-20mg THC edible before she goes to sleep to help her get the rest she needs, as well as micro doses of 1.25mg THC during the day. She has also used cannabis suppositories to treat pelvic pain.   “We know that with Fibromyalgia the sleep disruption causes a lot of the problems during the day. Your pain is worse if you don’t sleep, your fatigue is worse, your brain fog, not being able to focus is worse if you don’t sleep,” she explained. Fibromyalgia is a debilitating disease that causes widespread chronic pain as well as fatigue and memory problems, among other symptoms. It is about twice as common in women than in men.  Many Fibromyalgia patients use cannabis. Research has been limited but the studies that have been done demonstrated evidence of its effectiveness in treating chronic pain, as well as improving overall quality of life by improving sleep and other ancillary symptoms. The author of five books including “Vitamin Weed” and “Journal Yourself to Health: Break Free From Pain,” Ross said that cannabis cream “has really been a lifesaver,” and has made it possible to continue writing despite the pain.  Ross has also been very active in drug policy reform and is the founder of Infused Health, her personal patient consulting company. She also provides consultations on the therapeutic use of psychedelic mushrooms. Perhaps most uniquely though, in 2009 she became the first scientist to appear on CBS’ “Big Brother,” and lasted 66 days on the show.  Ross believes that the key to cannabis treatment is finding the right product for the patient. And she recommends patients start out with a nighttime edible.  “The number one thing I start with fibromyalgia patients is getting them on that edible at night because it’s going to be something that you know, you don’t feel that high while you’re asleep so it’s a very safe way to get cannabis into your life,” Dr. Ross said. She added that, “if you sleep good and you can keep your stress low, you can sort of almost put your fibromyalgia into remission.” Ross does stress though that even though she believes cannabis to be “the number one way to treat fibromyalgia,” it’s no silver bullet and there are all types of symptoms from fatigue to pain and spasms that may require different answers.  Regardless, one benefit of cannabis is pretty consistent across the board.  “Cannabis is great at reducing stress. Stress will make this disease much worse for you. So if all it does is help you relax, have a new day and help manage your stress, you’re going to have a better life with fibromyalgia,” she said.  For Ross, her current regimen is light years from the early days before she started using cannabis, when she was, in her words, on 12 different prescriptions and felt altogether miserable. She said it took her a couple years to figure out the right regimen for her, which she said is key to helping patients get back to having as good a life as possible. “The biggest thing is to be able to have those consistent days where you don’t have to take three days off of work because you’re in so much pain or you’re so fatigued that it affects your professional life. So the goal is really to get people to have as many good days as possible.” She added that for her, cannabis “really does set the bar where I’m not inflamed, I’m not in pain, my sleep is good, my mood is good. I’m not anxious, I’m not depressed, I feel almost the same as before I was diagnosed.”   This article was originally published on The Cannigma, and shared here with permission.

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Cannabis & Sleep

Cannabis & Sleep

As more and more countries (including India) are beginning to understand the benefits of cannabis medicine, it is becoming a popular alternative for treating sleep disorders, traditionally managed through a variety of medicines from sleeping pills to melatonin.   We live in a very busy time with constant distractions and the capability to stay connected to one another 24/7. While this connected lifestyle has many advantages, it does not often promote healthy sleeping habits, causing many of us to fall short on both sleep duration and quality. Research on the subject indicates that nearly 50% of individuals living in the United States suffer from some form of sleep disturbance.  SYMPTOMS, CAUSES, AND PREDISPOSITIONS Sleep disturbance can come in many forms ranging from poor sleep latency due to ‘mind-chatter’, to a formal diagnosis of chronic insomnia. While severity does vary, common symptoms and risk factors associated with sleep disturbance can include: Sleep Latency Waking Frequently Waking Early Excessive Somnolence Loss of Concentration/Focus Impaired Memory  Daytime Irritability Poor Work Performance Limited Social Interactions Increased Risk of Injury Increased Risk of Developing Type 2 Diabetes Increased Risk of High Blood Pressure Increased Risk of Heart Disease Increased Risk of Mental Health Issues (Depression, Anxiety) The quality of our sleep is deeply interconnecting with nearly every other aspect of our health, and can be substantially influenced by our sleeping environment. Individuals hoping to treat sleep disturbance should begin by identifying any relevant factors and predispositions that may be contributing to a poor night’s sleep. These can include: Age (60 and over) Alcohol Consumption Anxiety Caffeine Intake Chronic Pain Depression Eating Habits (Eating Before Bed) Exercise Habits Gastro-Esophageal Reflux Disease Irregular Sleep Habits Sleep Apnea Overactive Thyroid Travel / Jet Lag  Light Pollution Medication(s) Mental Health Napping Habits Noise Pollution Screen Time / Blue Light Exposure Stress Trauma Shiftwork Early Parenthood Home Life Schedule Social Schedule TRADITIONAL TREATMENT OPTIONS Sleep disturbance is often the result of other underlying medical conditions and as such the focus of treatment should first be on these conditions. There are many traditional ways to treat sleep disturbance and improve overall sleep quality, but there is no one-size-fits-all solution and many find themselves searching for alternatives. Common treatment options for sleep disturbance can include:  MEDICATION  LIFESTYLE Melatonin: A natural sleep hormone. Sleeping Pills: Effective for short term benefits. However, effectiveness can reduce over time, and there is a potential for addiction.  Medications for Treating Primary Conditions: Sleep quality can be improved via the use of analgesics and other medications used to treat primary conditions that contribute to sleeplessness. Avoiding/Reducing Caffeine Intake Adequately Comfortable Mattress/Pillow Limiting Evening Screen Time Limiting Late Night Food Intake Maintaining Regular Night Time Routines Meditative and/or Deep Breathing Exercises Regular Exercise Stress Management CANNABIS MEDICINE TREATMENT In parts of the world where people have access to cannabis, sleep disturbance is one of the most commonly cited reasons for seeking cannabinoid treatment. Data suggests that individuals using cannabis medicine to help treat the effects of sleep disturbance also commonly report reductions in the use of traditional sleep medications. Cannabis medicine is hardly a newly discovered treatment option, as many cultures have a history of utilizing cannabis for its medicinal potentials, such as improving sleep quality. Through constant innovation and regulatory changes, today’s cannabis medicine has been carefully developed using modern cultivation methods and technologies, as well as precise product formulating to allow for a more targeted treatment approach. Due to evolving legal frameworks around the world and the creation of new product formats, cannabis medicine has steadily grown in popularity as a trusted treatment option for sleep disturbance.  Cannabinoids interact with the body’s endocannabinoid system (ECS), which helps in maintaining equilibrium within many of the different functions and systems of the human body, including the regulation of sleep cycles. Research suggests that an endocannabinoid deficiency might be an underlying factor contributing to a variety of chronic conditions, an issue that can potentially be addressed through cannabinoid treatment. Research has shown that the use of cannabis medicine is associated with significant improvements in perceived insomnia, and that delta-9-tetrahydrocannabinol (THC) and cannabinol (CBN) can have sedating effects and can decrease sleep latency. Anandamide, an endocannabinoid that shares structural similarities with THC, can affect sleep patterns. Due to the similar effects of THC and anandamide on the body, THC can be sedating at certain doses. However, there is the potential for long-term impairment of sleep quality from prolonged use of THC. Cannabidiol (CBD) has been shown to have the potential to improve REM sleep. Research also suggests that CBD may be beneficial in cases where sleep disturbance is linked to anxiety-related disorders. Additionally, CBD may be able to modulate wakefulness through activating regions of the brain involved in triggering alertness. This has potentials in improving symptoms of drowsiness and fatigue following a poor night sleep.  Research also suggests the potential for cannabis medicine to be beneficial in the treatment of conditions related to sleep disturbance. Evidences has shown that cannabis medicine can reduce symptoms of chronic pain and associated poor sleep quality. Studies also indicate that cannabinoid treatment can be beneficial for patients suffering from obstructive sleep apnea (OSA) through improved respiratory stability. Patients suffering from post traumatic stress disorder (PTSD) may also benefit from cannabis medicine through a reduction in trauma related dreams, and reduced dream recall. The overall effect of cannabis medicine on sleep can be dependent on factors such as cannabinoids used, dosage, and delivery method. Terpenes found in cannabis can also play a role in sedating potentials. Products that are dominant in the terpene myrcene have been shown to have a greater potential for sedating effects. While the current body of evidence suggests a great deal of potential benefits, additional research is still needed to fully understand the therapeutic potentials and possible side effects of cannabis medicine as a treatment for sleep disturbance, insomnia, and other chronic conditions that contribute to reduced quality and duration of sleep. To begin your cannabis medicine journey today, book an appointment now with the Savikalpa Virtual Clinic for an online doctor consultation, or request more information from a member of our highly trained clinic staff (eclinic@savikalpa.com). We pride ourselves on being one of India’s most qualified sources of fast, friendly, and professional access to ayurvedic medicine online! Interested in learning more? Send us your questions (eclinic@savikalpa.com). It is our mission to educate patients in any way we can, and we would be delighted to hear from you. Research regarding cannabis and sleep: Cannabis, Cannabinoids, and Sleep: a Review of the Literature https://link.springer.com/article/10.1007%252Fs11920-017-0775-9  The role of the CB1 receptor in the regulation of sleep https://pubmed.ncbi.nlm.nih.gov/18514375/  Endocannabinoid Signaling Regulates Sleep Stability https://pubmed.ncbi.nlm.nih.gov/27031992/ Medical cannabis use in the United States: a retrospective database study https://jcannabisresearch.biomedcentral.com/articles/10.1186/s42238-020-00038-w  The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/20007734/  Cannabis species and cannabinoid concentration preference among sleep-disturbed medicinal cannabis users https://pubmed.ncbi.nlm.nih.gov/26151582/  Cannabis Affects Cerebellar Volume and Sleep Differently in Men and Women https://www.frontiersin.org/articles/10.3389/fpsyt.2021.643193/full  Recent legalization of cannabis use: effects on sleep, health, and workplace safety https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656354/ Therapeutic Uses of Cannabis on Sleep Disorders and Related Conditions https://pubmed.ncbi.nlm.nih.gov/31895189/  Cannabis, Cannabinoids, and Sleep: a Review of the Literature https://pubmed.ncbi.nlm.nih.gov/28349316/  Acute effect of vaporized Cannabis on sleep and electrocortical activity https://doi.org/10.1016/j.pbb.2019.02.012  Use of Cannabis to Relieve Pain and Promote Sleep by Customers at an Adult Use Dispensary https://doi.org/10.1080/02791072.2019.1626953  Cannabis Expectancies for Sleep https://doi.org/10.1080/02791072.2019.1643053  Cannabis, Pain, and Sleep: Lessons from Therapeutic Clinical Trials of Sativex®, a Cannabis-Based Medicine https://doi.org/10.1002/cbdv.200790150  Using cannabis to help you sleep: Heightened frequency of medical cannabis use among those with PTSD https://doi.org/10.1016/j.drugalcdep.2013.12.008  Medical Cannabis and the Treatment of Obstructive Sleep Apnea: An American Academy of Sleep Medicine Position Statement https://doi.org/10.5664/jcsm.7070  Cannabis use and sleep: Expectations, outcomes, and the role of age https://doi.org/10.1016/j.addbeh.2020.106642  Effects of Cannabis Consumption on Sleep https://link.springer.com/chapter/10.1007/978-3-030-61663-2_11  Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep https://doi.org/10.1177/0269881117699616  Recent cannabis use and nightly sleep duration in adults: a population analysis of the NHANES from 2005 to 2018 https://rapm.bmj.com/content/47/2/100.abstract  Cannabidiol, a constituent of Cannabis sativa, modulates sleep in rats https://doi.org/10.1016/j.febslet.2006.04.102  Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis https://doi.org/10.1093/rheumatology/kei183  Using recreational cannabis to treat insomnia: Evidence from over-the-counter sleep aid sales in Colorado https://doi.org/10.1016/j.ctim.2019.102207  Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes https://www.liebertpub.com/doi/full/10.1089/can.2016.0009 DISCLAIMER – All individuals accessing this site undertake full responsibility for their own assessment of the accuracy/relevance of any and all content found herein. The content found on this site is not intended to serve as a substitute for medical advice/diagnosis/treatment from a qualified and licensed health care provider. This information should also in no way be misconstrued as professional legal advice regarding legislative, regulatory or any other matters. Individuals should always seek guidance of fully qualified professionals.

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Can cannabis help with diabetes? – What do we know, and what guidance should be given to patients with diabetes?

Can cannabis help with diabetes? – What do we know, and what guidance should be given to patients with diabetes?

Despite conflicting research, there is evidence supporting cannabis' protective action against diabetes. Read on to learn about the current guidelines from medical organizations.   It is always important to discuss one’s full medical history with your health care provider before beginning any new form of medical treatment or procedure. This allows your doctor to screen for any potential risk factors, complications, or side effects that are commonly linked to certain conditions.  In the case of diabetes, it is currently not common for health care providers specializing in cannabis medicine to screen for diabetes in the way they would commonly screen and/or caution patients regarding risk factors such as a history of schizophrenia or heart disease.   The relationship between cannabis medicine and diabetes is an area still requiring more extensive research. However, there has been some clinical studies on the subject to go along with a significant level of anecdotal evidence. While some of the existing data is contradictory, clinical research has been able to identify a number of potential benefits as well as reasons for diabetic patients to take extra precautions when consuming cannabis medicine products. POTENTIAL BENEFITS Despite the lack of a robust body of research regarding cannabis and diabetes, current anecdotal and clinical evidence suggests that cannabis may have either a positive or neutral effect when consumed by patients with diabetes. The endocannabinoid system (ECS) plays a role in how the body regulates food intake and body weight. Studies have shown that individuals who consume cannabis have lower rates of obesity than those who have never consumed cannabis, as well as lower rates of diabetes. Research has also shown an association between cannabis consumption and smaller waists circumferences, lower fasting insulin levels, and lower HOMA-IR. Cannabis medicine that is cannabidiol (CBD) dominant can also potentially help prevent and/or treat arterial inflammation, peripheral neuropathy, diabetic retinopathy, and gastrointestinal pain/cramping.  In jurisdictions where patients have easy access to cannabis and hemp products, it has become common for diabetic patients (relying largely on anecdotal evidence) to self-medicate using cannabinoid medicine for: Stabilizing/controlling blood sugar levels Increased insulin sensitivity Maintaining a healthy body weight Neuropathic pain relief Nerve inflammation prevention Reducing arterial inflammation Improved circulation via vasodilation Lowering blood pressure Muscle cramp relief Controlling restless leg syndrome Preventing diabetic retinopathy Limiting gastrointestinal pain/cramping Depression Improved sleep quality CANNABINOIDS AND DIABETES Studies suggest that a variety of cannabinoids found in cannabis medicine can potentially offer differing benefits and/or treatment options for patients with type 1 and type 2 diabetes. Cannabidiol (CBD)  Potential to: Reduce hyperglycemia and control blood sugar Prevent/limit inflammation Reduce neuropathic pain Decrease oxidative stress Limit vascular hyperpermeability Increase insulin production Reduce cholesterol levels Prevent diabetic retinopathy Delta-9-Tetrahydrocannabinol (THC) Potential to: Improve insulin production Relieve neuropathic pain  Reduce fasting plasma glucose Elevate adiponectin levels Delta-9-Tetrahydrocannabivarin (THC-V)  Potential to: Reduce fasting plasma glucose Increase adiponectin levels Increase apolipoprotein A levels Improve pancreatic β-cell function Significantly more clinical research is still needed to properly establish any potential benefits. However, there is enough evidence to suggest the possibility that cannabis medicine could prove to be more effective in managing diabetes than current medication commonly used for treating diabetes. REASONS TO EXERCISE ADDITIONAL CAUTION Studies have identified several risk factors regarding cannabis use and diabetes. However, these factors are most commonly associated with the recreational use of cannabis products impairing a patients’ ability for effective self-management. Those consuming a high dosage of THC resulting in feelings of euphoria or being ‘high’, may also experience an impaired ability to consistently make good choices.  This impairment can lead to: Inadequate monitoring of blood sugar and ketone levels Irregular use of prescribed medications Increased appetite High caloric intake Increased consumption of carbohydrates  Acute blood pressure increase Changes in levels of physical activity Decreased triglycerides and high-density lipoprotein cholesterol Failure to properly identify symptoms of low blood sugar  This potential for impaired self-management has been shown to double the likelihood of type 1 diabetes patients experiencing diabetic ketoacidosis (DKA). DKA is the result of excess ketone production in the body causing one’s blood to become acidic. Individuals consuming recreational cannabis and/or a regular high dosage of THC dominant cannabis products should discuss the risks of DKA with their health care provider, and increase the frequency for checking blood sugar and ketone levels.  An additional risk factor for DKA in type 1 diabetes patients is the potential for experiencing cannabinoid hyperemesis syndrome (CHS). While CHS is a rare condition linked to daily long-term consumption of high dose cannabis products, it can cause severe bouts of vomiting resulting in dehydration and increased ketone levels. Failure to properly treat DKA can result in severe dehydration, brain swelling, and even death. Beyond the potential impacts of impairment on self-management behaviours, research has also indicated a potential increased risk for: Myocardial infarction Arterial occlusion Renal disease  Additionally, the regular consumption of cannabis in young adults is linked to an increased risk of prediabetes later in life, however this is not currently linked to an increased risk of developing diabetes. CURRENT GUIDANCE Organizations such as Diabetes Canada have prepared some basic guidance based on the evidence available in order to assist doctors, educators, and social safety awareness advocates in their goals of better educating and cautioning those living with diabetes. For patients with type 2 diabetes who are able to maintain their target glucose levels and who currently practice healthy behaviors (eating right, checking levels/taking medications regularly), the primary concern is to ensure that when using cannabis products, patients are able to continue to practice good behaviors. While there is evidence that cannabis use can help in stabilizing blood sugar levels, recreational use of cannabis has been linked to diabetic patients over eating and forgetting to check their levels and/or take their medications. Thus, it is prudent to caution and educate patients on maintaining healthy habits, even if they are unlikely to experience euphoria or feel ‘high’ when using a proper dosage of a cannabis medicine product. Diabetes Canada also recommends that recreational cannabis users with type 1 diabetes should be made aware of all potential risk factors and advised to check their blood sugar and ketone levels more frequently than usual. To begin your cannabis medicine journey today, book an appointment now with the Savikalpa Virtual Clinic for an online doctor consultation, or request more information from a member of our highly trained clinic staff (eclinic@savikalpa.com). We pride ourselves on being one of India’s most qualified sources of fast, friendly, and professional access to ayurvedic medicine online! Interested in learning more? Send us your questions (eclinic@savikalpa.com). It is our mission to educate patients in any way we can, and we would be delighted to hear from you. Research regarding cannabis and Diabetes: The Role of Cannabis and Cannabinoids in Diabetes https://doi.org/10.1177%2F1474651410385860 Cannabis Use as Risk or Protection for Type 2 Diabetes: A Longitudinal Study of 18 000 Swedish Men and Women https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098083/ Cannabis Smoking and Diabetes Mellitus: Results from Meta-Analysis with Eight Independent Replication Samples https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801109/ Efficacy and Safety of Cannabidiol and Tetrahydrocannabivarin on Glycemic and Lipid Parameters in Patients With Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled, Parallel Group Pilot Study https://diabetesjournals.org/care/article/39/10/1777/129/Efficacy-and-Safety-of-Cannabidiol-and The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults https://doi.org/10.1016/j.amjmed.2013.03.002 Obesity and Cannabis Use: Results From 2 Representative National Surveys https://doi.org/10.1093/aje/kwr200 Beneficial effects of a Cannabis sativa extract treatment on diabetes-induced neuropathy and oxidative stress https://hal.archives-ouvertes.fr/hal-00483244  Randomized Placebo-Controlled Double-Blind Clinical Trial of Cannabis-Based Medicinal Product (Sativex) in Painful Diabetic Neuropathy: Depression is a major confounding factor https://doi.org/10.2337/dc09-1029 A double-blind, randomized, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment https://doi.org/10.1002/j.1532-2149.2013.00445.x  Neuroprotective and blood-retinal barrier-preserving effects of cannabidiol in experimental diabetes https://pubmed.ncbi.nlm.nih.gov/16400026/ Cannabis use does not impact on type 2 diabetes: A two-sample Mendelian randomization study https://doi.org/10.1111/adb.13020 Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III https://pubmed.ncbi.nlm.nih.gov/22368296/ The effects of recreational cannabis use on glycemic outcomes and self-management behaviours in people with type 1 and type 2 diabetes: a rapid review https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-020-01411-9 Cannabis Use Is Associated With Increased Risk for Diabetic Ketoacidosis in Adults With Type 1 Diabetes: Findings From the T1D Exchange Clinic Registry https://doi.org/10.2337/dc19-0365 An Unusual Cause of Recurrent Diabetic Ketoacidosis in Type 1 Diabetes https://www.amjmed.com/article/S0002-9343(16)30290-X/fulltext Marijuana use, diet, body mass index, and cardiovascular risk factors https://doi.org/10.1016/j.amjcard.2006.03.024 The relationship between cannabis use and diabetes: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III https://pubmed.ncbi.nlm.nih.gov/30288813/ Marijuana Use and Type 2 Diabetes Mellitus: a Review https://pubmed.ncbi.nlm.nih.gov/27747490/ Marijuana use and risk of prediabetes and diabetes by middle adulthood: the Coronary Artery Risk Development in Young Adults (CARDIA) study https://pubmed.ncbi.nlm.nih.gov/26364621/  Cannabis use prevalence among individuals with diabetes: The National Survey on Drug Use and Health, 2005-2018 https://pubmed.ncbi.nlm.nih.gov/32470752/ Diabetes Canada Position Statement on Recreational Cannabis Use in Adults and Adolescents With Type 1 and Type 2 Diabetes https://doi.org/10.1016/j.jcjd.2019.05.010 DISCLAIMER – All individuals accessing this site undertake full responsibility for their own assessment of the accuracy/relevance of any and all content found herein. The content found on this site is not intended to serve as a substitute for medical advice/diagnosis/treatment from a qualified and licensed health care provider. This information should also in no way be misconstrued as professional legal advice regarding legislative, regulatory or any other matters. Individuals should always seek guidance of fully qualified professionals.

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Cannabis & Antibiotics

Cannabis & Antibiotics

Cannabis is a powerful anti-inflammatory, which is one of the primary reasons for its continued increase in consumption across the globe. However, can you take THC and CBD with antibiotics?   With the use of cannabis medicine becoming more and more common around the world, one frequently asked question among patients is, can I use cannabis medicine while taking antibiotics?   Cannabis and antibiotics are currently not considered to be contraindicated. While still ongoing, the current research regarding interactions between cannabis medicine and antibiotics is somewhat limited.  Among the data that does exist, studies have suggested the following: An increased potential for experiencing side effects related to the use of antibiotics, such as vomiting, nausea, and/or diarrhea.  Antibiotics may cause a reduction in CBD levels. Clindamycin can be found on at least one doctor compiled list of potential drug interactions related to cannabis. Based on the evidence available, the consensus appears to be that the potential for interaction is low, and patients should be made aware of the increased potential for vomiting, nausea, and/or diarrhea.  The increased risk of antibiotic related side effects I likely due to the potential for cannabis to inhibit certain enzymes (cytochrome p450 enzymes) within the liver. These enzymes are involved in the biosynthesis of some antibiotics such as erythromycin, miocamycin and troleandomycin.   Should a patient begin to experience any of these negative side effects, it is recommended that they consider reducing their cannabis medicine dosage, or discontinuing their cannabis medicine treatment until the course of antibiotics is complete. When reducing or ceasing dosage, patients should also be advised that they may experience a temporary worsening of the symptoms for which they are taking cannabis, such as pain or sleep disturbance. This is necessary to prioritize the antibiotics treatment. Beyond the research in the area of drug interaction potentials, there has also been some study regarding the possible antibiotic and antimicrobial properties of cannabis.  Research is still ongoing, however thus far cannabinoids have been shown to have the following potentials: CBG has been shown to be able to kill antibiotic-resistant bacteria, including Methicillin-Resistant Staphylococcus Aureus (MRSA). CBD can kill some forms of Gram-negative bacteria, including Neisseria gonorrhoeae. CBD has the potential to enhance the effectiveness of certain antibiotics. Major cannabinoids such as THC, CBD, CBG, CBC, and CBN have all been shown to have some level of effectiveness in killings different strains of MRSA bacteria. CBD shows a low tendency to produce resistance in bacteria. This research does look promising, however it’s important to remember that further study and formulation work is needed before we can determine the efficacy and viability of any new treatment options.  To begin your cannabis medicine journey today, book an appointment now with the Savikalpa Virtual Clinic for an online doctor consultation, or request more information from a member of our highly trained clinic staff (eclinic@savikalpa.com). We pride ourselves on being one of India’s most qualified sources of fast, friendly, and professional access to ayurvedic medicine online! Interested in learning more? Send us your questions (eclinic@savikalpa.com). It is our mission to educate patients in any way we can, and we would be delighted to hear from you. Research regarding cannabis and antibiotics: A Systematic Review on the Pharmacokinetics of Cannabidiol in Humans https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6275223/  An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies https://doi.org/10.1089/can.2016.0034  Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review https://doi.org/10.3109/03602532.2013.849268 A Phase I, open-label, randomized, crossover study in three parallel groups to evaluate the effect of Rifampicin, Ketoconazole, and Omeprazole on the pharmacokinetics of THC/CBD oromucosal spray in healthy volunteers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671111/  NTI Meds to be Closely Monitored when Co-Administered with Cannabinoids https://sites.psu.edu/cannabinoid/files/2020/06/NTI-Meds-to-be-Closely-Monitored-when-Co-Administered-with-Cannabinoids_2020_04_25.pdf Cannabis Interactions https://www.drugs.com/drug-interactions/cannabis.html  The Antimicrobial Activity of Cannabinoids https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400265/  The antimicrobial potential of cannabidiol https://pubmed.ncbi.nlm.nih.gov/33469147/  The antimicrobial effect behind Cannabis sativa https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.761  Cannabinoids-Promising Antimicrobial Drugs or Intoxicants with Benefits? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345649/  Antibacterial cannabinoids from Cannabis sativa: a structure-activity study https://pubmed.ncbi.nlm.nih.gov/18681481/  Uncovering the Hidden Antibiotic Potential of Cannabis https://pubmed.ncbi.nlm.nih.gov/32017534/   Cannabidiol is an effective helper compound in combination with bacitracin to kill Gram-positive bacteria https://www.nature.com/articles/s41598-020-60952-0  Antibacterial activity of delta9-tetrahydrocannabinol and cannabidiol https://pubmed.ncbi.nlm.nih.gov/1085130/  Immunoregulatory Role of Cannabinoids during Infectious Disease https://doi.org/10.1159/000481824 DISCLAIMER – All individuals accessing this site undertake full responsibility for their own assessment of the accuracy/relevance of any and all content found herein. The content found on this site is not intended to serve as a substitute for medical advice/diagnosis/treatment from a qualified and licensed health care provider. This information should also in no way be misconstrued as professional legal advice regarding legislative, regulatory or any other matters. Individuals should always seek guidance of fully qualified professionals.

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Cannabis and Drug Tolerance

Cannabis and Drug Tolerance

  How to take a tolerance break? The most effective method for reducing tolerance and regaining the full relief potentials of cannabis medicine, is by taking scheduled tolerance breaks.    Drug Tolerance / Drug Insensitivity When an individual develops a diminished response to a drug following a period or repeated use. Often this is the result of prolonged use of a drug causing one’s body to adapt to the constant presence of the substance. Classes of Drug Tolerance Dynamic Tolerance  – Adaptive changes to receptor sites in the brain. Dispositional Tolerance  – Changes in how a drug is absorbed by the body. Behavioral Tolerance  – Administration environment familiarity. It is not uncommon for individuals over time to develop tolerance to a medication, resulting in a drop in the effectiveness of symptom management from their prescribed dosage. This can occur through a change in how the body metabolizes a drug, or in the case of cannabis medicine, changes in cell receptors within the body (CB1 receptors). Common medications that are associated with drug tolerance/insensitivity also include: Opioids Antidepressants Antibiotics Anxiolytics Chemotherapy drugs In the case of cannabis medicine, tolerance is most commonly associated with patients who are consuming doses with a high potency of delta-9-tetrahydrocannabinol (THC) over an extended period of time. Tolerance can also be affected by one’s gender, DNA, pervious use history, and drug delivery method.  Cannabis tolerance is caused by the downregulation of the body’s CB1 receptors. The regular presence of THC in the body can inhibit CB1 receptor sensitivity, and reduce the number of CB1 receptor sites available for binding through receptor internalization.  In the short term, patients can benefit from an increased tolerance to THC through a reduction in potential unwanted side effects such as intoxication or psychomotor impairment. However, over time this tolerance can also lead to a limiting of the sedative and pain-relieving effects of THC.  Additionally, prolonged use of THC dominant cannabis medicine can potentially also result in increased synthesis of pregnenolone in the brain. Increased levels of this hormone might ultimately result in limiting the effects of THC by acting as a signal inhibitor for the CB1 receptor.  Mitigating Cannabis Drug Tolerance When discussing medical cannabis and drug tolerance, it is important to note that this downregulation of the body’s CB1 receptors is associated with THC consumption and not cannabidiol (CBD). Current research suggests that the consumption of CBD does not result in CB1 downregulation or an increase in drug tolerance. Thus, if a patient is able to achieve sufficient symptom management from CBD without the use of THC, they might be able to avoid or limit the effects of tolerance. The effects of cannabis tolerance can also be mitigated through the use of a dosage schedule that incorporates a gradual increase in dosage potency. By increasing dosage gradually, patients will be able to better maintain their experienced levels of symptom relief. However, as dosage potency increases, so does the rate of tolerance, thus regardless of how carefully one schedules their treatment regimen, they will eventually experience reduced effectiveness in symptom management. The most effective method for reducing tolerance and regaining the full symptom relief potentials of cannabis medicine, is through taking scheduled tolerance breaks (also known as ‘t-breaks’). Once a patient reaches the point where increasing their dosage to achieve greater efficacy is no longer deemed practical and/or safe, they should talk to their doctor about a tolerance break.  When a patient ceases their course of cannabis treatment for a tolerance break, research suggests that the replenishment of CB1 receptor availability can begin within the first 48 hours. Some in the medical cannabis community recommend that patients who rely on cannabis for the treatment of chronic conditions should consider taking a two day break once every 30 days, in order to limit the effects of tolerance.  For those who’s condition/symptom severity will allow for longer breaks, research indicates that after a break of two weeks, experienced effects should begin returning to normal. In four weeks, CB1 receptor function/density is observed to return to near normal.   After taking a tolerance break, patients should be aware that they might now be more susceptible to the intoxicating effects of THC than they were prior to taking this break. Patients should thus consider starting again at a lower dosage, both to avoid unwanted effects, and to gauge the possible therapeutic potentials of a lower dose. Cessation and the Potential for Withdrawal Symptoms Anecdotally, patients reporting that they have experienced withdrawal symptoms after stopping a course of cannabis treatment is generally uncommon, and usually involves symptoms of low to moderate severity. However, various studies on the subject have reported the rate of patients who experience some form of withdrawal symptoms as being anywhere from 35% to 75%, with a noted potential for greater symptom severity to be experienced by women. Patients who report experiencing withdrawal symptoms typically begin experiencing symptoms between 24-72 hours following cessation. With peak symptoms being experienced after seven days. Mild symptoms can potentially persist for as many as four weeks. The associated symptoms of cannabis withdrawal and their limited severity are sometimes likened to those commonly associated with caffeine withdrawal. Potential symptoms can include: Sudden return and/or increased severity of symptoms being managed Reduced Appetite Upset Stomach and/or Nausea Sleep Disturbance Vivid Dreams Irritability Mood Swings Restlessness Fatigue Headaches Loss of Focus Depression Dysphoria Patients are recommended to help manage withdrawal symptoms by staying well hydrated, getting plenty of bed rest, and engaging in regular exercise to achieve a natural boost in one’s mood. Over-the-counter remedies can be useful in managing symptoms of nausea and headache. There is also some evidence to suggest that CBD can potentially help in alleviating symptoms of withdrawal.  Weaning of Dosage Prior to Cessation In light of the evidence suggesting that there is a possibility of experiencing some form of withdrawal symptoms, it would be prudent for patients to speak with their doctor about a gradual weaning of one’s dosage prior to ending a course of treatment or beginning a tolerance break. This should be considered if frequently consuming a high THC dosage and/or an extended duration of treatment. While the gradual weaning off of cannabis medicine is far less common than immediate cessation, there is the possibility that it may help further reduce the potential for experiencing withdrawal symptoms.  For those wishing to limit the possibility of experiencing these symptoms through weaning, patients should gradually decrease the THC potency of their dosage as well as dosage frequency over the course of approximately ten days. Dosage should also be limited to the evenings while weaning, in order to best limit potential symptoms of sleep disturbance. EXAMPLE WEANING CHART: Original Dosage DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8 DAY 9 DAY 10 Potency (THC) 10mg 10mg 7.5mg 7.5mg 5mg N/A 5mg N/A 2.5mg N/A 2.5mg Frequency x 2 Morning /Evening x 1 Evening Only x 1 x 1 x 1 N/A x 1 N/A x 1 N/A x 1 To begin your cannabis medicine journey today, book an appointment now at the Savikalpa Virtual Clinic for an online doctor consultation, or request more information from a member of our highly trained clinic staff (eclinic@savikalpa.com). We pride ourselves on being one of India’s most qualified sources of fast, friendly, and professional access to cannabis medicine online! Interested in learning more? Send us your questions (eclinic@savikalpa.com). It is our mission to educate patients in any way we can, and we would be delighted to hear from you. Research regarding cannabis and drug tolerance: Cannabis use and the development of tolerance: a systematic review of human evidence https://www.sciencedirect.com/science/article/abs/pii/S0149763418302665  Reversible and regionally selective downregulation of brain cannabinoid CB1 receptors in chronic daily cannabis smokers https://www.nature.com/articles/mp201182  Rapid Changes in CB1 Receptor Availability in Cannabis Dependent Males after Abstinence from Cannabis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4742341/ Rapid CB1 cannabinoid receptor desensitization defines the time course of ERK1/2 MAP kinase signaling https://www.sciencedirect.com/science/article/abs/pii/S0028390807001712  Blunted highs: Pharmacodynamic and behavioral models of cannabis tolerance https://www.sciencedirect.com/science/article/abs/pii/S0924977X20300225  Time course for the induction and maintenance of tolerance to Delta(9)-tetrahydrocannabinol in mice https://pubmed.ncbi.nlm.nih.gov/10940538/  Regional enhancement of cannabinoid CB1 receptor desensitization in female adolescent rats following repeated Δ9-tetrahydrocannabinol exposure https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2962820/  Regulation of CB1 cannabinoid receptor internalization by a promiscuous phosphorylation-dependent mechanism https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3707135/  Aspects of tolerance to and dependence on cannabis https://pubmed.ncbi.nlm.nih.gov/828472/  Clinical relevance of cannabis tolerance and dependence https://pubmed.ncbi.nlm.nih.gov/6271820/  Cannabidiol regulates behavioural alterations and gene expression changes induced by spontaneous cannabinoid withdrawal https://pubmed.ncbi.nlm.nih.gov/29624642/  Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146100/  The Grass Might Be Greener: Medical Marijuana Patients Exhibit Altered Brain Activity and Improved Executive Function after 3 Months of Treatment https://www.frontiersin.org/articles/10.3389/fphar.2017.00983/full  The cannabis withdrawal syndrome: current insights https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414724/  Sex differences in cannabis withdrawal symptoms among treatment-seeking cannabis users https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747417/  DISCLAIMER – All individuals accessing this site undertake full responsibility for their own assessment of the accuracy/relevance of any and all content found herein. The content found on this site is not intended to serve as a substitute for medical advice/diagnosis/treatment from a qualified and licensed health care provider. This information should also in no way be misconstrued as professional legal advice regarding legislative, regulatory or any other matters. Individuals should always seek guidance of fully qualified professionals.

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Why cannabis can make your heart race

Why cannabis can make your heart race

One of the most common unwanted side effects of cannabis, a spike in heart rate, also happens to be one of the most troublesome and can even turn new users off from the plant. “If you don’t explain that it’s possible that you can have a little acceleration of the heart for maybe 5 or 10 minutes and that it’s nothing to worry about,” said Janosch Kratz, MD, on The Cannabis Enigma podcast, “he gets nervous and says, ‘oh God, why did I take this drug.'” For a healthy individual cannabis-induced tachycardia is usually harmless, and knowing more about what cannabis is doing to your body can make you feel better about the unpleasant feeling. So why can cannabis raise your heart rate? Is it dangerous? And what can you do about it? Let’s find out.  How cannabis affects your heart in general Cannabis has a number of common side effects, ranging from mild ones such as red eyes, dry mouth, or the munchies, to potentially more unpleasant effects such as anxiety, paranoia, and short-term memory difficulties.  These side effects, and how cannabis affects the cardiovascular system, are related to how it modulates what is known as the endocannabinoid system. The endocannabinoid system affects a wide range of bodily functions including hunger, pain, sleep, and energy, to name a few.   The major active chemicals in cannabis — cannabinoids — are able to trigger receptors that control the endocannabinoid system, modifying the function of those receptors and the connected systems, including the cardiovascular system.   “The interactions of the endocannabinoid system with the autonomic nervous system seem to be the driving force behind the reported cardiovascular adverse events [from cannabis],” wrote a group of researchers who recently reviewed years of cannabis studies1.  Why cannabis makes your heart race  An increased or irregular heart rate, also known as tachycardia, can be a side effect of cannabis use. In fact, smoking cannabis can lead to a 20-100% increase in heart rate for a couple hours or more after consumption2. This is believed to be due to a widening of the blood vessels, which is also responsible for those red eyes people get after using cannabis.  In higher doses cannabis can also lead to a drop in blood pressure, resulting in dizziness and lightheadedness. The main culprit for these effects of cannabis is widely-considered to be tetrahydrocannabinol (THC), the cannabinoid also responsible for the high of marijuana.  One of the more oft-cited, albeit dated reports states that inhaling cannabis smoke and ingesting THC reliably increases the heart rate by 20-50% over baseline. A lab study carried out on rodents in 1985 further showed that THC significantly alters the levels of catecholamine — hormones that are produced by the adrenal glands and are responsible for the body’s “fight or flight” response — in the bloodstream. Research has also shown that as one’s tolerance to cannabis increases, the severity of side effects often decreases3. This means that side effects commonly seen with inhaled cannabis, including increased heart rate and reduced blood pressure, is not as common in regular users. It should be noted that almost all studies on the risks of cannabis use are based on people who inhaled marijuana smoke, and that with more and more people now preferring other methods and types of cannabis, these risk assessments should be updated. In other words, like with some other cannabis side effects, the effect on heart rate can be partly attributed to the act of smoking itself4.  Could lower THC strains affect your heart rate less? Since THC is often cited as being responsible for the increased heart rate after cannabis use, one might logically conclude that choosing lower-THC strains — or lower doses in general — would help mitigate it. It would also follow that eating edibles high in THC could produce the same side effects.  Dr. Deepak Cyril D’Souza, a professor of psychiatry at the Yale University of Medicine told NBC news in November, 2020 that he has spent 25 years studying the effects of marijuana and THC and that “in our studies on THC, we found a very robust increase in heart rate and an effect on blood pressure that can be quite profound.” A 1988 trial found that women given very low-THC (1.8%) joints showed “statically significant increases in pulse rate,” and this increase was more pronounced and lasted longer for participants with a past history of intermittent marijuana use5. The trial did not include a control population given a lower dose of THC however.  The most well-known and common strains (more correctly referred to as “chemovars”), high in THC and low in cannabidiol (CBD) and often bred for a strong high and medicinal benefits, are increasingly referred to as Type I cannabis. Type II chemovars have more of a balance between CBD and THC, while Type III chemovars are CBD dominant with little-to-no THC.  All types of cannabis can be used therapeutically, but types II and III tend to allow for better control of THC doses and are often preferred by healthcare professionals due to the reduced risk of side effects. Type III cannabis, despite containing small amounts of THC, is generally considered non-intoxicating. What about CBD?  It is increasingly accepted that CBD, which doesn’t cause an intoxicating effect, can counteract some of the effects of THC6. This happens because CBD can actually modify THC binding with certain receptors of the endocannabinoid system. In other words, using a strain that has less THC or more of a CBD-dominant profile, should — by virtue of containing less THC — produce a less powerful high, and may reduce the anxiety that can commonly accompany a THC high. As far as the effects CBD itself has on the heart, a 2017 trial found that a single dose of CBD reduced resting blood pressure and helped mitigate stress-induced blood pressure and heart-rate increases7.  A 2013 comprehensive published in Frontiers in Psychology looked at CBD’s ability to offset the “adverse psychological effects of THC,” and concluded that “the few studies that exist on the effects of CBD show that this cannabinoid can counteract some of the negative effects of THC.”  Is sativa or indica worse for your heart rate? It’s conventional wisdom in cannabis that sativa strains are upbeat and indica strains are mellow and likely to induce the “couch lock” sensation. Countless cannabis consumers use these characterizations to shape their consumption or purchasing decisions Unfortunately, there isn’t much scientific evidence to support this notion of indica vs sativa as a method of distinguishing between the effects of different types of cannabis. While there are many factors at play in determining why a cannabis chemovar produces certain effects, calling them indica or sativa is not one.  What does matter is the cannabinoid profile of the chemovar (how much THC, CBD, and other cannabinoids) and its terpene makeup. The various terpenes in cannabis not only determine its flavor and aroma, but may also have a big impact on its effects, including how energetic or sedative the high is.  Also, it’s worth keeping in mind that this can be very individualistic. The right dose for one individual can be very different than the right dose for another person, and a strain that makes one person very upbeat and giggly could induce a couch-lock sensation for someone else. And while a specific strain may be very relaxing to one person, another user could experience anxiety or paranoia, but this would not indicate that this is a universally-experienced effect of the cannabis variety in question. The same could be true for increased heart rate. Is cannabis dangerous for the heart?  View this post on Instagram A post shared by Savikalpa Academy (@savikalpa.academy)   If you are a young, healthy person with no history of cardiac illness, then you probably should not be overly concerned about the cardiovascular side effects of cannabis use.  A 2018 review of existing research into marijuana use and cardiovascular risk factors found that there is “insufficient” evidence about how marijuana affects cardiovascular risk factors including stroke and heart attack8. The researchers stated that the current literature on the matter is limited by “recall bias, inadequate exposure assessment, minimal marijuana exposure, and a predominance of low-risk cohorts.” That doesn’t mean that there may not be cause for concern. In fact, there is a substantial amount of data to suggest cannabis may increase the risk of cardiac disease Researchers in 2014 examined the reporting of cardiovascular complications related to cannabis use and found that they “indicate cannabis as a possible risk factor for cardiovascular disease in young adults.”9 More recently, a 2017 review discussed “harmful effects of cannabis use including fatal cardiovascular events that could be related to cannabis use,” including but not limited to increased heart rate and blood pressure and a heightened risk of acute coronary events10.  Cardiac-related mortality data from the U.S. National Vital Statistics System for 1990-2014 and showed a statistically significant increase of 2.4% in the rate of cardiac death among men following the passage of medical cannabis programs, as well as 1.3% increase among women11.  Other research has found that cannabis use is associated with an increased risk of cardiac dysrhythmia12, as well as non-fatal stroke, transient ischemic attack13, and acute myocardial infarction14. Importantly, cannabis users are more likely to be using tobacco products than non-cannabis users, which may contribute to these negative cardiac outcomes. In general, if you are considering using cannabis, you may want to speak to your physician about the possible side effects, especially if you have a history of cardiovascular issues. Can you do anything about increased heart rate from cannabis? When it comes to cardiovascular health and cannabis, many of the same healthy lifestyle principles apply: Try to limit or cut out smoking as an intake method, exercise regularly, eat healthy, and try to get a full night’s sleep as often as possible.  If you find that you often get anxiety or your mind (along with your heart) races when you get high, then consider trying a lower-THC variety, or one that has more of an even balance between THC and CBD. This will help keep your THC dose lower and reduce the likelihood of a racing heart and racing mind. And when those intense feelings strike, use some tried and true ways to bring your high down a little bit. First off, don’t panic. Remember that the high will wear off before too long, and this isn’t a permanent condition. Try to focus on your breathing, taking deep breaths to help you relax and bring your anxiety down. You can also try to find something funny on the TV, put on an album you love listening to, and when in doubt, raid the cupboard for snacks. Sources Latif, Z., & Garg, N. (2020). The Impact of Marijuana on the Cardiovascular System: A Review of the Most Common Cardiovascular Events Associated with Marijuana Use. Journal of clinical medicine, 9(6), 1925. https://doi.org/10.3390/jcm9061925 Goyal, H., Awad, H. H., & Ghali, J. K. (2017). Role of cannabis in cardiovascular disorders. Journal of thoracic disease, 9(7), 2079–2092. https://doi.org/10.21037/jtd.2017.06.104 Jones R. T. (2002). Cardiovascular system effects of marijuana. Journal of clinical pharmacology, 42(S1), 58S–63S. https://doi.org/10.1002/j.1552-4604.2002.tb06004.x Subramaniam, V. N., Menezes, A. R., DeSchutter, A., & Lavie, C. J. (2019). The Cardiovascular Effects of Marijuana: Are the Potential Adverse Effects Worth the High?. Missouri medicine, 116(2), 146–153. Lex, B. W., Mendelson, J. H., Bavli, S., Harvey, K., & Mello, N. K. (1984). Effects of acute marijuana smoking on pulse rate and mood states in women. Psychopharmacology, 84(2), 178–187. https://doi.org/10.1007/BF00427443 Laprairie, R. B., Bagher, A. M., Kelly, M. E., & Denovan-Wright, E. M. (2015). Cannabidiol is a negative allosteric modulator of the cannabinoid CB1 receptor. British journal of pharmacology, 172(20), 4790–4805. https://doi.org/10.1111/bph.13250 Jadoon, K. A., Tan, G. D., & O’Sullivan, S. E. (2017). A single dose of cannabidiol reduces blood pressure in healthy volunteers in a randomized crossover study. JCI insight, 2(12), e93760. https://doi.org/10.1172/jci.insight.93760 Ravi, D., Ghasemiesfe, M., Korenstein, D., Cascino, T., & Keyhani, S. (2018). Associations Between Marijuana Use and Cardiovascular Risk Factors and Outcomes: A Systematic Review. Annals of internal medicine, 168(3), 187–194. https://doi.org/10.7326/M17-1548 Jouanjus, E., Lapeyre-Mestre, M., Micallef, J., & French Association of the Regional Abuse and Dependence Monitoring Centres (CEIP-A) Working Group on Cannabis Complications* (2014). Cannabis use: signal of increasing risk of serious cardiovascular disorders. Journal of the American Heart Association, 3(2), e000638. https://doi.org/10.1161/JAHA.113.000638 Goyal, H., Awad, H. H., & Ghali, J. K. (2017). Role of cannabis in cardiovascular disorders. Journal of thoracic disease, 9(7), 2079–2092. https://doi.org/10.21037/jtd.2017.06.104 Latif, Z., & Garg, N. (2020). The Impact of Marijuana on the Cardiovascular System: A Review of the Most Common Cardiovascular Events Associated with Marijuana Use. Journal of clinical medicine, 9(6), 1925. https://doi.org/10.3390/jcm9061925 Hemachandra, D., McKetin, R., Cherbuin, N., & Anstey, K. J. (2016). Heavy cannabis users at elevated risk of stroke: evidence from a general population survey. Australian and New Zealand journal of public health, 40(3), 226–230. https://doi.org/10.1111/1753-6405.12477 Hemachandra, D., McKetin, R., Cherbuin, N., & Anstey, K. J. (2016). Heavy cannabis users at elevated risk of stroke: evidence from a general population survey. Australian and New Zealand journal of public health, 40(3), 226–230. https://doi.org/10.1111/1753-6405.12477 Mittleman, M. A., Lewis, R. A., Maclure, M., Sherwood, J. B., & Muller, J. E. (2001). Triggering myocardial infarction by marijuana. Circulation, 103(23), 2805–2809. https://doi.org/10.1161/01.cir.103.23.2805   This article was originally published on The Cannigma, and shared here with permission.

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What is the entourage effect?

What is the entourage effect?

The entourage effect is a hypothesis that was first suggested in the early 2000s, based on the notion that consuming a whole plant may be more effective than taking an isolated medication that is based only on one of a plant’s active compounds.  The hypothesis has been developed a lot since it was first posited. Today, some scientists believe different types of cannabis can be more or less effective for specific conditions and symptoms — and also the type of high they can cause — based on their chemical profiles.   What is the entourage effect? Most prescription drugs are based on a single molecule. There are even two FDA-approved drugs based on the two main molecules in cannabis — the cannabinoids THC and CBD. Cannabis, however, is a plant containing hundreds of compounds.  In 1999, researchers Shimon Ben Shabat and Raphael Mechoulam first mentioned that, as a plant, cannabis may be superior to some pharmaceuticals thanks to the effect of entourage compounds. This hypothesis was based on their observations when researching the endocannabinoid system, however, not the cannabis plant.  They observed that some endocannabinoids naturally produced in the body are more effective when delivered with other, non-active compounds. Or in their words, “Biologically active natural products… are in many instances accompanied by chemically related, though biologically inactive, constituents… Investigations of the effect of the active component in the presence of its ‘entourage’ compounds may lead to results that differ from those observed with the active component only.”  They concluded that “this type of synergism may play a role in the widely held (but not experimentally based) view that in some cases plants are better drugs than the natural products isolated from them.”  A couple of years later, researcher Elizabeth Williamson provided evidence for the concept that “a whole or partially purified extract of a plant offers advantages over a single isolated ingredient.”1  One of the examples used was the ability of CBD to attenuate some of THC’s side effects. She concluded that “this synergistic effect will become very important if cannabis becomes a medicine by reducing the often undesirable psychotropic side effects.”    How does the entourage effect work?  Though a number of researchers have contributed to the entourage effect theory as it relates to cannabis, the name most associated with it is Dr. Ethan Russo. In his 2011 paper, “Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects,” Russo thoroughly presented the previous works on cannabinoid synergy, basically coined the term “entourage effect,” and defined its mechanism.2 To explain how the entourage effect works, Dr. Russo cited a 2009 study from Germany that defined the way herbal synergy works in general, not just in cannabis. It described four main mechanisms, three of which are particularly relevant for cannabis:3 Multi-target enhancing effects Most often, drugs operate on one or two molecular targets in our bodies, creating a specific effect. A multi-target effect means plant compounds can operate on many targets. In cannabis, a popular example would be the interaction of THC with CB1, CB2, GPR18, GPR55, TRPV2, TRPV3, and many other receptors. This multitude of targets can potentiate the effects of THC.But it’s not just about THC — there are other cannabinoids, terpenes, and maybe even flavonoids that can also potentially activate a multitude of targets, thereby enhancing or modulating the effects of THC. One of the earliest published examples of the potentiating effects of THC when administered in a synergistic manner, was the comparison of a pure THC medication with a whole plant extraction in the treatment of spasticity. With equal doses of THC, a whole plant extraction was deemed “considerably more effective antispastically than THC alone.”4 Molecular movement enhancing effects The two main branches of pharmacology are pharmacodynamics (how drugs affect your body) and pharmacokinetics (how your body affects drugs, or the movement of drugs within the body). While the multi-target enhancing effects of cannabis are associated with the former, the movement enhancing effects of cannabis are related to pharmacokinetics.  The result is similar (an enhanced effect of THC or CBD), but the way there is a bit different. The multi-target enhancing effect is caused by the interaction of molecules on a variety of targets. While the movement enhancing effects of whole-plant cannabis is caused by the way a group of molecules (an entourage) travels in the body in a more efficient manner than if one of them travels alone.  One example of molecular movement enhancing effects is exemplified by the terpenes limonene and pinene. These terpenes are biologically active,5,6 and can cause relaxation of the lungs and airway, but when taken may not themselves produce a major bodily response (at least not at safe doses). But when terpenes are inhaled along with cannabinoids, the absorption of cannabinoids through the lungs could be improved by the presence of these bronchodilating terpenes.  Modulation of adverse effects These effects “can be reached when a constituent contained in a plant extract…’neutralizes’ or destroys a toxicaly acting constituent and, therefore, generates a better effectiveness as compared with the original raw drug.”7Several adverse effects of cannabis are associated with THC, and though there are a few cannabis compounds that may help counteract these adverse effects, the best and most popular is CBD.There is a growing amount of research supporting the ability of CBD to attenuate THC adverse effects, particularly impaired memory8, anxiety9, and psychotomimetic effects (such as paranoia and social withdrawal)10.  Terpenes and cannabinoids – the entourage effect in cannabis In “Taming THC,” Dr. Russo also added a new research direction: Maybe it’s not just the interaction of THC and CBD but also other cannabis compounds — such as minor cannabinoids, terpenes, and flavonoids — that play a role in the entourage effect. Terpenes are aromatic molecules responsible for the smell and taste in most plants, but they are also pharmacologically active and can influence the body. One of the unique things about cannabis is its terpene content variability (there are almost 200 different terpenes in cannabis).  According to Dr. Russo, the abundant terpenes in a given chemovar are likely to determine its effects. Those terpenes may influence whether it’ll be sedating or stimulating, and whether it will be better for conditions and symptoms such as pain, inflammation, anxiety, epilepsy, or depression.  Some examples of potential cannabinoid-terpenoid synergy suggested in “Taming THC” include:  THC + pinene = Bronchodilator THC + limonene, pinene or linalool = Beneficial in Alzehimer THC + linalool and/or myrcene = Muscle relaxant CBD + linalool and/or limonene = Anxiolytic CBD + linalool = Anticonvulsant CBD + limonene = Immunostimulant CBD + pinene = Anti-inflammatory THC and/or CBD + linalool = Analgesic  Though there’s some evidence for cannabinoid synergy (mainly THC and CBD), the terpenoid-cannabinoid synergy, as logical as it may be, is  only supported by little evidence for now. But this may be due to lack of research on the matter.   How to take advantage of the entourage effect There are a few ways to practically use this information, but before we dive into that, it’s important to note that terpenoid-cannabinoid synergies are mostly based on preliminary research. While it does make a lot of sense, there isn’t a lot of concrete evidence to support whether it can work on humans. The most important rule when it comes to the entourage effect is to seek out cannabis flowers or whole-plant products over isolates. Then, there are a number of actions you can take to optimize your experience, or when choosing the right strain for you.  Define an objective. What are you trying to achieve with cannabis? Have a relaxing evening, better focus when working, treat seizures, relieve pain? Investigate. Learn about the cannabinoids and terpenes that have been shown to be potentially useful for what you’re trying to achieve. Explore. Look for chemovars high in these cannabinoids and terpenes. Test. Conduct some trial and error until you find the chemovar that fits you.  Cannabis research still has a long way to go. For now, there’s no way to suggest a specific cannabis product for a given condition or use. But you can use the information we do have to narrow down the possibilities.  What if I don’t have access to the chemical profile?  If you live in a place with no legal cannabis program, or if your neighborhood dispensary doesn’t provide more information than the THC and CBD content of their products, you may still have other ways to sprinkle some entourage in your weed.  Let’s say you’d like to have two main chemovars in your life, one for a good night’s sleep, and another that’s more energizing and focusing for daytime. According to the entourage effect, pinene could help with memory and focus, while beta-caryophyllene (BCP) and linalool may help with insomnia.  All you need to do is infuse your cannabis with some extra pinene for your daytime chemovars, and BCP or linalool for your nighttime chemovar. There are a few ways in which you can do that, and they all involve other plants or their essential oils. However, keep in mind that these methods are based on logic rather than scientific literature.  Also, as described earlier, terpenes aren’t unique to cannabis — they can be found all over nature. In fact, while the variability of different terpenes in cannabis is unique, the total terpene content in cannabis is rather poor compared to other plants, and usually ranges between 1-3.5%.11 In comparison, the essential oil of lavender may consist of more than 85% terpenes12. Here are some ways to get some more terpenes in your weed: 1) Add in botanicals Get some dry lavender flowers and add them to your nighttime chemovar before you smoke or vape it. The high concentration of linalool from the lavender could synergize with the THC and CBD in your weed. For your daytime chemovar, you can add some dry rosemary leaves, which are often high in pinene that may help with memory and concentration. Be sure to use dried, clean herbs if trying this and be aware that a little goes a long way. 2) Buy it infused Get some terpene infused rolling papers, these can increase the terpene content of whatever you’re inhaling. Different brands offer infused papers and suggest the potential effects they may create. For instance, uplifting, relaxing and joyful.  3) Set the aroma or mood Try to guide your cannabis experience with external terpenes by diffusing essential oils while you enjoy your cannabis. Get a diffuser, close the doors and windows, and diffuse a few drops of essential oils (rosemary or sage, for instance, are high in pinene). Once the odors of the essential oil starts kicking in, take a few deep breaths and enjoy the scent, then proceed to smoking or vaping your weed. For night time, you can use the essential oil of clove or cinnamon for some BCP, or an essential oil of lavender or sage for some linalool.  4) Infuse the herbs Here you can use either dry herbs or essential oils, though the latter may work better as they have higher concentration of terpenes. When putting your cannabis flowers in a container (preferably made of glass), if you add another source of terpenes, the flower within the container will absorb some of the added terpenes from the air in the jar. To infuse your weed with herbs,  add some dry rosemary, lavender, or clove to your jar of cannabis or place a few drops of essential oils on some cotton balls and leave them in the jar with the cannabis flowers so they can absorb the terpenes.  If you are using essential oils, make sure to use quality products from reputable brands such as doTERRA or Neal’s Yard, as this is an unregulated market that often offers low quality products with questionable ingredients. How the entourage may change the industry Assuming that the entourage effect is true, and cannabinoids and terpenes can synergize and play a role in how different types of cannabis influence the body, there may be some practical implications for cannabis researchers, consumers, health care professionals, growers, and manufacturers. What the entourage effect means for consumers  One of the main implications of the entourage effect for consumers will be the way they choose cannabis products. If the cannabinoid and terpenoid profiles of cannabis plants determine their effects, we will need a system to categorize and group these products.In an ideal world, after a lot of research is done on the entourage effect, cannabis products could be grouped for uses and treatments best suited for conditions and symptoms such as pain, sleep, nausea, headaches, and seizures. They could also be distinguished as daytime or nighttime evening products, better suited for a slow evening, partying, or working.  In any case, the current strain names or indica/sativa nomenclature won’t cut it when it comes to chemical profiles. They only refer to morphological differences at best, and often completely ignore the chemical profiles of cannabis products. What the entourage effect means for research  Two of the main limitations of cannabis research are a lack of funding and conflicting results. Both are related to the entourage effect.   Conventional therapies usually use drugs that are based on one or two molecules that bind to one or a few receptors. The entourage effect intrinsically defies that approach. It suggests an herbal synergy in cannabis, in which multiple compounds target multiple targets.This encourages a paradigm shift: Should researchers distinguish between cannabis chemotypes or chemovars? Chemotypes are either high in THC or CBD (or they can have a 1:1 ratio). Chemovars, on the other hand, look past the CBD:THC ratio, and are defined by the exact concentrations of cannabinoids, and their most abundant terpenes.Moving forward with chemovars, while using the preliminary research suggested by the entourage effect may help lead researchers to more accurate results. At the moment there may be different studies that investigate how cannabis can help with a given condition or symptom. But sometimes researchers are using entirely different formulations — sometimes just THC, sometimes a mixture of THC and CBD, or even a whole plant extraction.  According to the entourage effect hypothesis, comparing the results of many of these studies is flawed because they often test different treatments altogether.  If the hypothesis is accurate, then future studies should use a more precise chemovar-driven approach to researching cannabis. It could provide health care professionals with valuable insights into therapy, and provide consumers clearer guidance on expected effects of a particular product.  The only problem is that cannabis is a plant, and patenting a plant is no picnic. There is very little incentive to fund expensive clinical trials with specific chemovars — a return on investment comparable to pharmaceutical drugs is unlikely. In addition, the illegality of cannabis has prohibited and effectively banned university-based research that often occurs in emerging fields like cannabinoid science, which is why many of the questions raised by the entourage effect remain unanswered. What the entourage effect means for cultivation and production The entourage effect may also affect cannabis cultivation, as it will need to evolve to meet the future demands of the market. Nowadays most chemovars are just high in THC with varying terpenes, but mostly high in myrcene or beta-caryophyllene.  If consumers start seeking out cannabis with more diverse chemical profiles in order to take better advantage of the entourage effect, there will most likely be an increase in demand for varying concentrations of THC and CBD and other minor cannabinoids, but also of a larger variety of terpenes.  On the production side, there will be a need for a more elaborative labeling, one that presents more than just the THC and CBD concentrations, but also other cannabinoids and terpenes. This could happen — and in some places is already happening — either because consumers are demanding to know more, or because of regulations that mandate it. Criticism  More than 20 years have passed since the first mention of a potential entourage effect in cannabis, but not all scientists agree with the hypothesis. In fact, some openly cast doubt on it.  In a recent article in the journal, “Expert Review of Clinical Pharmacology,” Peter Cogan argued that there is a lack of sufficient scientific evidence to support the entourage effect, that it’s often presented as an established clinical phenomenon as opposed to an hypothesis, and pointed to the vast misuse of that information by marketers in order to promote their cannabis products.13 Indeed, some of this criticism is valid. When the entourage effect was first suggested, it was proposed as an hypothesis — an observed phenomenon that needs to be further investigated. Nevertheless, cannabis companies, particularly CBD ones, use it in their promotional content to promote their whole plant based products as healthier and more efficient.  The lack of evidence, on the other hand, may reflect more on the lack of research rather than on the lack of entourage. In addition, the review ignores some of the more concrete clinical evidence for herbal synergy in cannabis, some of which was presented above.  Other recent studies that looked for evidence of a terpenoid-cannabinoid entourage couldn’t find evidence for such activity. They were preclinical studies that didn’t involve human subjects, however. 14, 15 On the other hand, another recent study does provide early evidence of a cannabis entourage effect. Researchers from the University of Arizona found that terpenes such as alpha humulene, linalool, and beta pinene can boost cannabinoid activity. Furthermore, the researchers wrote, they “are multifunctional cannabimimetic ligands,” or molecules that mimic cannabinoids, “that provide conceptual support for the entourage effect hypothesis and could be used to enhance the therapeutic properties of cannabinoids.”16 There’s a growing number of countries and states that legalize medical use of cannabis, even though they already have access to CBD and THC pharmaceutical drugs. And there is some scientific evidence17 and a lot of anecdotal reports showing that both THC and CBD pharmaceutical preparations are more likely to cause side effects than whole plant preparation with equivalent amounts of either THC or CBD.  Herbal synergy in cannabis likely does exist, and it could help explain the variable effects of cannabis. However, there’s a lot of hype and marketing around the entourage effect but very limited scientific evidence to support the theory.  Sources https://pubmed.ncbi.nlm.nih.gov/11695885/ Russo E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British journal of pharmacology, 163(7), 1344–1364. https://doi.org/10.1111/j.1476-5381.2011.01238.x Wagner, H., & Ulrich-Merzenich, G. (2009). Synergy research: approaching a new generation of phytopharmaceuticals. Phytomedicine : international journal of phytotherapy and phytopharmacology, 16(2-3), 97–110. https://doi.org/10.1016/j.phymed.2008.12.018 https://pubmed.ncbi.nlm.nih.gov/19211237/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524888/ https://pubmed.ncbi.nlm.nih.gov/26456328/ https://pubmed.ncbi.nlm.nih.gov/19211237/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435777/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719112/ https://pubmed.ncbi.nlm.nih.gov/29161743/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767019/ https://pubmed.ncbi.nlm.nih.gov/32116073/ https://doi.org/10.1089/can.2019.0016 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6757239/ https://www.nature.com/articles/s41598-021-87740-8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334252/   This article was originally published on The Cannigma, and shared here with permission.

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